Sight and Life Magazine 1/2011

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34 THE FEASIBILITY OF DELIVERING VITAMIN A TO NEWBORNSfigure 5: Map of districts in Bangladesh whereNVAS is being pilotedNilphamariJaldhakaand DimlaupazilasIndia(WestBengal)PirojpurSadar andNesarabadupazilas0 25 50 KilometersTangailJaldhakaand DimlaupazilasIndia(Assam)India(Tripura)Myanmar(Burma)and home- or clinic-based antenatal (ANC) visits (Figure 7). Inaddition to key ANC services and messages, pregnant womenreceive an individually packaged dose of vitamin A (50,000 IU),and are instructed about why, when, and how to administer thedose to their newborns, and how to manage potential side effects.This information is accompanied by a counseling cardand a “Health Worker Contact Card” that includes the name,cell phone number, and address of the local health worker. Thepotential advantage of this model is that the VA supplement isin the home at the time of delivery, and does not require thenotification of or waiting for the arrival of a health worker toadminister the dose.2. The “Health Worker Dosing” model also uses FWAs and HAs;however, the mother or a family member must contact the healthworker at the time of birth and the health worker must visit themother and her newborn to directly administer the vitamin A(Figure 8). To facilitate birth notification, health workers informpregnant mothers about the importance of early birth notificationso that the baby can obtain newborn vitamin A and otheressential newborn services. In this model, a “Health WorkerContact Card” is also provided to promote prompt and directcommunication with the health worker.Monitoring and evaluation. Monitoring the pilot activitiesinvolves a two-pronged strategy consisting of (1) routine datacollection within the MoHFW system; and (2) special monitoringinterviews and observations conducted by locally hired“extenders” to assess how well NVAS is being integrated intoexisting ANC and postpartum visits, and to assess communityacceptability (Figure 9). Two cross-sectional surveys in eachprogram upazila, or region, at baseline and at six months afterimplementation (i.e. end-line), will be conducted among recentlydelivered mothers to assess coverage and timeliness of thedelivery of newborn vitamin A. In addition, community healthworkers (CHW) will be surveyed at baseline and end-line toassess knowledge, attitudes, and practices about integratingNVAS into existing services.figure 6: NVAS design workshop participantsin Bangladeshdesign workshop, including national, district and sub-districtlevel health and family planning managers, was held in October2010 (Figure 6) and proposed two delivery platforms:1. The “Mother / Family Member Dosing” model in Bangladeshuses two cadres of community health workers: The “Female WelfareAssistant” (FWA) and the “Health Assistant” (HA), who integratesNVAS into routine home-based pregnancy surveillanceConclusionsBoth Nepal and Bangladesh have made important strides in bridgingthe research-to-program gap by examining scientific evidenceand its relevance within each country’s context, establishingpolicies that permit feasibility testing of this new intervention,and closely monitoring and evaluating NVAS implementationbefore formulating a policy for national scale-up. From preliminarydata, implementation challenges facing NVAS are similar tothose faced by other interventions that target pregnant womenand newborns. These include identifying and reaching a highproportion of pregnant women and their newborns in a timelymanner, overcoming geographic, travel and time constraints
SIGHT AND LIFE | VOL. 25 (1) | 2011 THE FEASIBILITY OF DELIVERING VITAMIN A TO NEWBORNS 3535figure 7: Mother/Family Dosing ModelPregnancyContact Points> Home-based pregnancyidentification/registration> Home-based ANC visit> Satellite-clinic ANC visit> FWC-based ANCActionsAntenatal contact with pregnant womenPregnant women given NVAS and instructedon why, what, when, how and who will give NVAS(integrated into usual ANC services/counseling)BirthPhone callActionsMother or family members gives NVAS tonewborn within 2 days of birthPostpartum (0–2 days after birth)Contact Points> Postnatal home visit by FWAor HAActionsFWA or HA confirms newborndosing and doses baby if missedfigure 8: Health Worker Dosing ModelPregnancyContact Points> Home-based pregnancyidentification/registration> Home-based ANC visit> Satellite-clinic ANC visit> FWC-based ANCActionsAntenatal contact with pregnant womenPregnant women given NVAS and instructedon why, what, when, how and who will give NVAS(integrated into usual ANC services/counseling)BirthPhone callBaby is born,please come!ActionsFamily member contacts health worker bymobile phone or drops card at clinicPostpartum (0–2 days after birth)Contact Points> Postnatal home visit by FWAor HAActionsHealth worker directly doses newborn
Page 1 and 2: VOL. 25 (1) | 2011Sight and Life16
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Page 6 and 7: 6What is abrand ?It would be imposs
Page 8 and 9: 8EDITORIALOur history between two c
Page 10 and 11: 10 SIGHT AND LIFE STATEMENTSight an
Page 12 and 13: 12 SIGHT AND LIFE STATEMENTcolonic
Page 16 and 17: 16THE IMPORTANCE OF VITAMIN AThe Im
Page 18 and 19: 18 THE IMPORTANCE OF VITAMIN Afor t
Page 20 and 21: 20 THE IMPORTANCE OF VITAMIN ARetin
Page 22 and 23: 22 THE IMPORTANCE OF VITAMIN ADespi
Page 24 and 25: 24 THE IMPORTANCE OF VITAMIN Afigur
Page 26 and 27: 26 THE IMPORTANCE OF VITAMIN Afigur
Page 28 and 29: 28 THE IMPORTANCE OF VITAMIN A30. M
Page 30 and 31: 30THE FEASIBILITY OF DELIVERING VIT
Page 32 and 33: 32 THE FEASIBILITY OF DELIVERING VI
Page 36 and 37: 36 THE FEASIBILITY OF DELIVERING VI
Page 38 and 39: 38FROM AGRICULTURE TO HORTICULTURE
Page 40 and 41: 40 FROM AGRICULTURE TO HORTICULTURE
Page 42 and 43: 42 FROM AGRICULTURE TO HORTICULTURE
Page 44 and 45: 44IRON FORTIFICATION - NEW REVELATI
Page 46 and 47: 46 IRON FORTIFICATION - NEW REVELAT
Page 56 and 57: 56 OPINION 1 / 2depending upon spec
Page 58 and 59: 58A DAY IN THE LIFE OF JOHANN C JER
Page 60 and 61: 60 A DAY IN THE LIFE OF JOHANN C JE
Page 62 and 63: 62ewsFourth AfricaNutritional Epide
Page 64 and 65: 64 THE FIRST GLOBAL CONFERENCE ON B
Page 66 and 67: 66 THE FIRST GLOBAL CONFERENCE ON B
Page 68 and 69: 68 NEW DEVELOPMENTS IN CAROTENOIDS
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Page 72 and 73: 72Reportfrom GogounouBlessings at t
Page 74 and 75: 74 REPORT FROM KATHMANDUReportfrom
Page 76 and 77: 76 REPORT FROM KATHMANDUPregnant wo
Page 78 and 79: 78 REPORT FROM RATANAKKIRIReport fr
Page 80 and 81: 80nd Life Special Research Grant 20
Page 82 and 83: 82 WHAT'S NEWEach Task Force is fin
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84 WHAT'S NEWgroups; distribution c
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86 WHAT'S NEWFood and nutrition sec
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88 WHAT'S NEWricesYet Again …09Ri
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90 WHAT'S NEWA2Z: The USAID Micronu
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92 WHAT'S NEW4ne Collaboration Join
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94WHAT'S NEW17Atmala’s Medal of S
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96Comments on the Comparison of the
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98Editor’s note: Sight and Life r
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100 PUBLICATIONSOmega-3Fatty Acids
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Sharingknowledgefor improvednutriti
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Buildingbridgesfor betternutrition.
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